Abstract

Background

Frailty is a complex syndrome that is associated with aging but not synonymous with the normal aging process. It has been associated with all-cause mortality, but less is known about frailty and mortality from specific causes.

Data and methods

Data from the 2013 and 2014 Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics - Death Database were used to estimate the prevalence of frailty among Canadians aged 65 or older. Levels of frailty were based on validated cut-points for the 30-item frailty index. The relationship of frailty to mortality risk during the period of three to five years following the CCHS interview was assessed with Cox proportional hazards models adjusted for sociodemographic factors and health behaviours. Associations between frailty and mortality from neoplasms, circulatory diseases and disease of the respiratory system were examined in separate models.

Results

An estimated 1.1 million (22%) community-dwelling older adults were frail in 2013 and 2014, and another 1.6 million (32%) were considered pre-frail. Frailty was more common among females than males and among those in older age groups. The risk of mortality increased significantly with increasing levels of frailty, even after accounting for sociodemographic factors and health behaviours. This was the case for all-cause mortality, as well as for death from three major underlying causes—neoplasms, and diseases of the circulatory and respiratory systems.

Interpretation

Even individuals who were classified as pre-frail had an increased risk of mortality overall and from three leading causes compared with those who were robust, demonstrating the importance of screening community-dwelling older adults for frailty.

Keywords

aging, death, mortality, population study, probabilistic linkage

DOI: https://www.doi.org/10.25318/82-003-x202100400002-eng

Findings

Frailty is a complex syndrome that involves multiple body systems – older adults who are frail typically experience a state of increased vulnerability resulting from an accumulation of age- or disease-associated decrements. There is an accelerated loss of physiological reserves, which lowers resistance to stressors and—subsequently—the ability of frail individuals to avoid and recover from illness or trauma. Frailty is increasingly common at older ages but is not synonymous with the aging process, as the health status of individuals of the same age can differ dramatically. [Full article]

Authors

Heather Gilmour (Heather.Gilmour@canada.ca) and Pamela L. Ramage-Morin are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario.

 

What is already known on this subject?

  • Frailty is a complex syndrome that is associated with aging but not synonymous with the normal aging process. It is characterized by a state of increased vulnerability resulting from an accumulation of age- or disease-associated decrements.
  • There is a health-survival paradox—females are more likely than males to be frail, but males who are frail are more likely to die than females who are frail.
  • The association between frailty and all-cause mortality is well established, but few studies have examined frailty in association with cause-specific mortality.

What does this study add?

  • In 2013 and 2014, an estimated 22% of community-dwelling older Canadians were frail, similar to the proportion reported 20 years earlier in another Canadian study. An additional 32% were considered pre-frail.
  • Greater levels of frailty were associated with a higher risk of all-cause mortality and death from three major underlying causes: neoplasms, and diseases of the circulatory and respiratory systems.
  • Even older adults who were classified as pre-frail—i.e., having a slightly elevated score on the frailty index that was nevertheless below the threshold for frailty—had a higher risk of mortality from each of these causes than those classified as robust.

End of text box

Date modified: